Bybrook House Nursing Home

Bybrook House Nursing Home is a care home, which provides personal and nursing care to up to 30 people. However, there are some twin rooms that are used for single occupancy. This means the home usually accommodates up to 22 people. The home also supports people living with dementia. At the time of the inspection, 14 people were living at the home.

People’s experience of using this service and what we found

There were systems in place to assess risk and ensure measures were in place to enhance people’s safety. People felt safe within the home and were confident to raise any concerns if needed. Relatives confirmed this and were sure any issues would be quickly resolved.

People received their medicines safely, as prescribed. Staff had fully completed the records to evidence this. Medicines were stored securely although one medicine was incorrectly kept in the fridge. This was quickly addressed once brought to staff’s attention. There was detailed information about the administration of “as required” medicines. This ensured the medicines were safely administered.

Robust infection prevention and control measures were in place and government guidance was being followed in relation to COVID-19. This ensured regular testing, social distancing and strict procedures for visiting. The home was clean, and staff had access to personal protective equipment (PPE). This was worn and disposed of correctly.

There were enough staff to support people safely. Staff covered each other at times of sickness or annual leave and there was limited agency use. This enabled people to have consistency with their care. People were supported when required, and call bells were answered in a timely manner.

The registered manager was experienced and displayed strong leadership. They worked closely with people and staff, to develop relationships, and monitor service delivery. There was a clear ethos based on key values, and a desire to continually improve. Staff knew people well, which promoted person centred care.

There were various audits to check the safety and quality of the service. This included areas such as infection control, the environment and staff training. People, their relatives and staff were encouraged to give their views about the running of the home. Any feedback was considered and implemented if possible.

Rating at last inspection

The last rating for this service was good (14 November 2017).

Why we inspected

This was a planned inspection based on the previous rating.

The service was due a comprehensive inspection but due to the pandemic, we are not routinely completing comprehensive inspections. We have covered safe and well-led to assess whether good practice, seen at the last inspection, has been maintained.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bybrook House Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bybrook House Nursing Home provides accommodation, nursing and personal care for up to 24 older people. At the time of our inspection there were 13 people living in the home.

There is a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our last inspection in February 2016 found areas which required improvement in relation to the administering and management of medicines. We had received an action plan setting out how the provider would address these areas. These areas included administering of PRN or "As Required" medicines, recording of medicines changes and maintaining the effectiveness of medicines through checking of environment temperatures. The provider had made the required improvements to ensure the safe storage and management of medicines.

At this inspection the arrangements for supporting people with their medicines were good and people received their prescribed medicines at the times required and people's health and welfare were protected.

The arrangements for the monitoring of pressure mattresses which are used where people are at risk of skin breakdown were not effective. There were a number which were not at the correct setting. People who were in bed and needed to be re-positioned to protect their skin integrity were not always re-positioned at the time intervals recorded in their care records.

People told us they felt safe and staff recognised and were confident about reporting any concerns about the safety and welfare of people. One person told us "I feel safe because I trust the staff, they know what they doing." A relative told us they felt confident their relative was safe and said, "When I leave the home after visiting I know (name) is safe and well looked after I do not worry about them."

The service was responsive to people's changing care needs and had good arrangements for getting support from outside professionals such as tissue viability nurses and dieticians. There were regular reviews of people care needs and people or their representatives had an opportunity to discuss their care needs so care plans accurately reflected their health and social care needs.

People and relatives told us staffing arrangements were good and staff were available at a time they were needed. Staff responded promptly to requests for help and support. One person told us "The staff are there when I need them."

There was a welcoming environment where people were able to maintain their relationships with family and friends. People and relatives told us there were no restrictions on visiting.

People felt able to voice their views or concerns about the service. There were regular meetings where people living in the home could give feedback about the quality of care provided in the home.

People spoke of staff being caring and kind. This was confirmed by relatives we spoke with. One told us "Staff are so caring and friendly." We observed staff supporting people in a sensitive and caring manner.

People had the opportunity to take part in activities of their choice. There was a varied menu, offering a number of daily choices and people were very positive about the quality of meals. One person said, "The food is very good I always enjoy my meal and we always get a choice."

People, relatives and staff spoke highly about the registered manager and senior staff. They were described as "Approachable and always there to listen." The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs. When concerns were raised during the inspection the registered manager was responsive to the matters raised and to ensuring improvements were made.

Further information is in the detailed findings below

There was a registered manager in post when we inspected the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager was accessible and approachable throughout our inspection. Staff, relatives and people who used the service told us the registered manager was available if they needed to speak with her and had confidence in her abilities to manage the service.

Risks to individuals and the service were not always managed effectively and assessments put in place were not being followed correctly. This meant there was the potential for harm to come to people.

The home’s medicine management systems required improvement in order to fully protect people.

Staff understood their responsibilities in reporting any safeguarding concerns and had confidence in the registered manager that these would be fully investigated to keep people safe.

Not all staff had received regular training, suitable for their position which meant they potentially lacked the knowledge and skills to effectively fulfil their role.

Staff were receiving regular supervisions, which the registered manager had put in place so staff could be supported in their development.

People and relatives were very complimentary about the food and choices available. Mealtimes were an enjoyable experience and menus were tailored to meet individual’s preferences.

Staff were knowledgeable about people’s needs and people’s privacy and dignity was always respected. Staff explained the importance of supporting people to make choices about their daily lives. People told us they were involved in decisions about their care and systems were in place to monitor and review people’s changing needs.

Care plans were in an accessible format and contained information about the person which enabled person centred care to be provided. However the recording of information was not always completed, meaning people’s needs were not monitored effectively for changes to be identified in a timely manner.

The registered manager had created a positive and open culture in the time they had been in post. Relatives spoke about the changes they had seen and felt reassured the home was moving in the right direction.

Quality audits were undertaken; but some findings indicated that action was not always taken in response to these audits and some recordings were not an accurate reflection of events in the home. We saw that an event that is notifiable to CQC, concerning a pressure wound had not been reported.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During the day we spoke with five people who lived in the home, a volunteer and eight members of staff. People told us that staff were dedicated and caring and we observed this to be the case. It was evident through observation and discussions with staff that they enjoyed working in the home and supporting people.

The visiting professionals we spoke with had high praise for the quality of the care people who lived in the home received.

Part of this inspection was to follow up three outcome areas where we required the provider to make improvements. We found that the necessary improvements had been made to, the recording of communications, staff supervision and auditing of supervision and appraisals.

We observed that staff worked hard but were primarily task focused. Staff did not often engage in social interaction with people, for example sitting and talking with people. Staff told us they would like to have the time to be able to sit and talk with people, hold their hand or offer emotional support as they considered this was part of their caring role.

People told us they felt Bybrook House was a safe place to live and that staff treated them with respect. People told us they liked the staff and were well looked after. One person said, "the staff are lovely, so kind and do their job really well".

We found that the home did not have an overview of staff supervision or appraisal. We could not be assured therefore, that staff were being adequately supported in their roles.